Abstract
Objective: Patients with hematologic malignancies are at risk for severe thrombocytopenia (sTP). The risk and benefit of aspirin therapy is not known in thrombocytopenic cancer patients who experience an acute myocardial infarction (AMI). Methods: Medical records of patients with hematologic malignancies diagnosed with AMI at Memorial Sloan Kettering Cancer Center during 2005-2014 were reviewed. sTP was defined as platelet count <50 cells k/μL within 7 days of AMI. Demographics, aspirin use, survival and bleeding outcomes were collected. T-tests and Fisher exact tests were used to compare continuous and categorical variables. Survival rates were calculated using the Kaplan-Meier product limit method; groups were compared with log-rank statistic. Results: 118 patients with hematologic malignancies had AMI. 58/118 (49%) had sTP. 25/58 (43%) of those with sTP received aspirin. Patients were mostly male (70%, n=83), mean age 69±11 years, mean follow up 3.6 years. Non-Hodgkin’s lymphoma was the most common hematologic diagnosis (36%, n=42). Survival was significantly worse in patients with sTP vs. no sTP (23% vs. 50% at 1 year, log rank p=0.008). When compared to no sTP with AMI, patients with sTP and AMI were less likely to receive aspirin (83% vs 43%, p=0.0001), thienopyridine (27% vs 3%, p=0.0005) and to undergo coronary angiography (30% vs. 5%, p=0.0005) and revascularization (17% vs. 3%, p=0.03). Cancer patients with sTP and AMI who received aspirin had improved survival when compared to those not treated with aspirin, (92% vs. 70% at 7 days, 72% vs. 33% at 30 days and 32% vs. 13% at 1 year, log rank p=0.008). No fatal bleeding events occurred. Thrombolysis in Myocardial Infarction (TIMI) major bleeding occurred in one patient without sTP. Conclusions: In hematologic malignancy patients with AMI and sTP the use of aspirin was associated with improved survival without increase in major bleeding.
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